Phillip William Berg, D.C.
Individual provider Active NPI Chiropractor · Champlin, MN
NPI 1831374446 · NPPES record last updated Dec 15, 2016
Key facts
- NPI
- 1831374446
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5047 (MN)
- Practice address
- 11468 Marketplace Dr N
Suite 500
Champlin, MN 55316-3872 - Phone
- (763) 421-2710
- NPI assigned
- Jan 2, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Chiro RX, LTD.
Practice addresses (Care Compare)
2625 24TH Ave S
Suite B
Grand Forks, ND 58201-6180
Phone (701) 746-7979
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080501000143 | ND | Practitioner - Chiropractic | 8426137647 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5047 | MN | MD | Chiropractor |
| 815 | ND | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sundby Family Chiropractic PC | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5047 | MN | Yes |
| Chiropractor | 111N00000X | 815 | ND |
Addresses
Primary practice location
11468 Marketplace Dr N
Suite 500
Champlin, MN 55316-3872
Mailing address
2625 24TH Ave S
# B
Grand Forks, ND 58201-6180
Phone (763) 421-2710
Other providers in Champlin, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.